Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance.
Medical treatment of neurocardiogenic syncope is insufficient in many cases. We have observed a therapeutic effect of repeated head-up tilt testing. Therefore, we have started a program of tilt training for heavily symptomatic patients. After hospital admission, they were tilted daily (60 degrees inclination) until syncope, or until a duration of 45-90 minutes (90 sessions in 13 patients). The mean tilt tolerance, at the first diagnostic head-up tilt table test, was 22.3 minutes (st. dev. 10.9). Before hospital discharge, 12/13 patients could sustain the full duration of tilt table testing without any symptom. In one patient syncope persisted. The patients were instructed to continue a program of daily tilt training at home, by standing against a wall for 30 minutes, one or two times per day. This resulted in a complete disappearance of syncope in all 13 patients. Orthostatic intolerance and the excessive autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training, without the administration of drugs.
Ector
H
H
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. Hugo.Ector@med.kuleuven.ac.be
Reybrouck
T
T
Heidbüchel
H
H
Gewillig
M
M
Van de Werf
F
F
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007024:Hypotension, Orthostatic / Q000534:rehabilitation*; D008297:Male; D011187:Posture / Q000502:physiology; D012008:Recurrence; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000534:rehabilitation*; D018667:Tilt-Table Test; D013997:Time Factors